Background: this study aimed to assess the hypothesis that essential hypertens ion (EH) may increase coronary microcirculation dysfunction in patients with typ e 2 diabetes mellitus(DM). Microvascular dysfunction has been reported in patien ts with DM or EH. Discordant results have been reported on cumulative adverse ef fects of the simultaneous presence of DM and EH on coronary flow velocity reserv e (CFR). Methods: CFR were compared in 13 hypertensive diabetics (group 1), 12 n ormotensive diabetics (group 2), 11 hypertensive non diabetics (group 3) and 29 normotensive non diabetic patients (group 4). CFR was calculated using an intrac oronary Doppler tipped flow wire. Results: CFR was significantly lower in patie nts with both DM and EH (2.2±0.4 in group 1 vs 2.8±0.5, 2.8±0.6 and 2.9±0.7 in groups 2, 3 and 4 respectively, p< 0.01). The presence of hypertension reduce d CFR in diabetic patients with angiographically abnormal but unobstructed coron ary arteries (2.1±0.3 in hypertensive vs 3.1±0.2 in normotensive diabetic pati ents, p< 0.02). No cumulative adverse effect was observed in diabetics with angi ographically normal coronary arteries (2.3±0.6 in hypertensive vs 2.6±0.5 in n ormotensive diabetic patients, NS). Multivariate analysis revealed that combinat ion of DM and EH (p< 0.007) was independently related to CFR. Conclusions: the p resence of hypertension appears to worsen coronary microangiopathy in diabetic p atients with unobstructed coronary artery disease. The cumulative effect of EH a nd DM on CFR impairment has consequences for decision making during coronary ang ioplasty and could identify patients at risk for cardiomyopathy.
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